By Dr. Gautum Nayak
The people of North Central Washington (NCW) are socially, ethnically and economically diverse. Our medical needs present challenges not encountered in urban areas. Yet, our current regional health care system can skillfully provide almost everything we need, from primary care to neurosurgery. A strong health care system is foundational for our growing regional economy. Our patients and our community cannot risk losing what has become one of the country’s best rural health care systems, but if the Affordable Care Act (ACA) is repealed, this is a real possibility.
The ACA (Obamacare), while not perfect, has had a profoundly positive impact in Washington for most people. Over 10,000 people in Chelan County alone are newly covered and the number of uninsured in Washington has fallen from 14 percent to an all-time low of 5.8 percent. Insurers can no longer deny coverage for pre-existing conditions or put a lifetime cap on payments for your health care costs. Health insurance plans must provide 10 essential health benefits (including emergency care and prescription drugs) and preventive services at no cost to you (no co-pay or deductible). These provisions lead to better care.
Illness will eventually strike all of us, or someone we hold dear. Whether you live in Oroville or Moses Lake, we must ensure that when you need care, it continues to be available. There is a cost to having a high-quality health care system with skilled, readily available providers and evolving technology. If some individuals cannot pay for their care, then valuable clinical resources will instead be spent on charity care. If illness is not identified at early stages, our emergency rooms will get busier, costs will soar and outcomes will be poorer. While the most seriously ill will always need and receive the most resources, if there is not a way to cover these costs, our rural health care system will not remain financially viable. This will affect all of us, irrespective of our insurance plan.
The House of Representatives recently passed the American Health Care Act (AHCA) and the Senate is currently debating its similar Better Care Reconciliation Act (BCRA). These bills are designed to remove many of the ACA coverage requirements, while re-instating pre-ACA tax breaks for those with higher incomes. The House bill and Senate proposal will cut Medicaid funding by more than $770 billion over the next 10 years, and the Congressional Budget Office estimates that over 20 million Americans will lose coverage under both plans. Rural areas like ours will be hit the hardest.
Nearly 30 percent of the people in NCW are Medicaid beneficiaries; the majority work but earn near the federal poverty level. If you have Medicare or private insurance, either self-purchased or through your employer, why should this matter? Think about your current doctor or specialist. If resources become more limited and our health care system is unable to provide care to everyone in the region, will your physician be able to stay and have a viable practice? Will you have to travel to Seattle to get the care you’ve come to expect in this region? Will our health care system be able to handle a complicated, life-threatening illness in a timely fashion? It’s difficult to even contemplate these scenarios. In an AHCA or BCRA world where essential health benefits are removed, lifetime caps on costs are imposed, insurance costs for many nearing retirement escalate, and where those with pre-existing conditions are placed in meagerly funded high-risk pools, these scenarios may become a reality.
Losing funding and coverage protections for the most vulnerable individuals will inhibit our ability to provide the best care in a timely fashion, for everyone. The ACA, while imperfect, set a new bar for what we in NCW should expect in a health care system that tries to work for everyone. Going backwards shouldn’t be an option.
The ACA needs to be improved, especially for those above the poverty level struggling to afford quality coverage. Both sides of the political aisle need to come together, and we as a community need to hold our leaders accountable. As physicians working in a system rooted in an ethos of providing great care to everyone in NCW, we remain committed to practicing medicine in a manner that benefits us all.
The ACA has been successful in Washington and our region, and the proposed alternatives could be devastating. The improvements brought about since 2010 have translated into cost savings, improved quality and better patient outcomes. Therefore, we cannot support either the AHCA or the BCRA. Rather, we believe the best way to maintain our outstanding rural healthcare system is to work to improve upon the strong foundation created by the Affordable Care Act.
Dr. Gautum Nayak is employed by Confluence Health. More than 90 other regional health care professionals co-signed this article.